Before-and-after images of cosmetic work are a staple feature of advertisements and other marketing material.

However, there are important ethical considerations to bear in mind. You may be aware that you should never reproduce identifiable images of patients without your patient's consent, but what about images that aren't identifiable?

The guidance

In its guidance on making and using visual recordings of patients, the GMC states:

You must get the patient's consent, ideally in writing, to make a recording specifically for use in widely accessible public media, such as the internet or in a magazine, even if you think the patient is not identifiable in the recording. This will involve explaining, in a way the patient can understand, the purpose of the recording and how it will be used, how long the recording will be kept and how it will be stored.
You should reassure patients that they may withhold consent during or immediately after the recording without affecting the quality of care they receive.
The patient's consent should be recorded in the medical notes.

For most cosmetic surgeons, before-and-after images are an intrinsic part of patient care, and form part of the patient record.

For images taken as part of treatment that may then be used for a secondary purpose, such as marketing:

Discuss with the patient at the outset.
When seeking consent, you should explain that the images may be used in an anonymised form at a later stage for a secondary purpose.
If they do not want their image to be used for any other reason, you should record this explicitly in the record.

Where patients have not had the opportunity to consent to their image being used in the media, the GMC suggests it is 'good practice to seek their consent' even if you believe the image is anonymised.

If this is not practicable, the GMC says the image can still be used although you should bear in mind "it may be difficult to ensure that all features of a recording that could identify the patient to any member of the public have been removed". It may be difficult for a doctor to justify their actions if a patient recognises their image in an advertisement and complains, so it's advisable not to proceed without a record of patient consent.

Doctors also need to consider whether their marketing material meets GMC standards on probity.

The GMC's Guidance for doctors who offer cosmetic interventions (2016) states that you must:

"market your services responsibly, without making unjustifiable claims about interventions, trivialising the risks involved, or using promotional tactics that might encourage people to make ill-considered decisions".

When publishing information about your services:

It must be factual and verifiable.
It must not make unjustifiable claims about quality or outcome, or mislead patients about the results you are likely to achieve.
It must not offer guarantees of cures, exploit patients' vulnerability or lack of medical knowledge.
You must not put pressure on people to use a service.

Marketing material must also conform to the UK Advertising Codes. This includes a section specifically about promoting medicines, medical devices, health-related products and beauty products.

The Advertising Standards Authority (ASA), which enforces the Code, can demand the withdrawal of adverts and offenders can even be referred to the Office of Fair Trading.

Marketing with before-and-after images

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